Transplant Infections

pp 357-380


Gram-Negative Bacterial Infections After Hematopoietic Stem Cell or Solid Organ Transplantation

  • Diana AverbuchAffiliated withPediatric Infectious Diseases Unit, Hadassah Hebrew University Medical Center Email author 
  • , Dan EngelhardAffiliated withPediatric Infectious Diseases Unit, Hadassah Hebrew University Medical Center

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Reemergence of gram-negative rods (GNR) is reported in hematopoietic stem cell (HSCT) and solid organ transplant recipients (SOTR). The main GNR are Enterobacteriaceae, followed by Pseudomonas aeruginosa; other more rare non-fermentative GNR include Acinetobacter spp., Burkholderia cepacia, Stenotrophomonas maltophilia. Infections caused by GNR may present with diverse clinical picture: bacteremia, pneumonia and other local site infections. Clinical course may be fulminant, with septic shock. Prognosis is frequently worse. Resistance to multiple antibiotic classes, including carbapenems, is growing and it compromises prophylaxis and treatment options. Previous colonization with resistant bacteria and previous exposure to antibiotics are the most important risk factors for infection with resistant bacteria. Treatment of carbapenem-resistant GNR is challenging; in some cases, the only treatment options include old antibiotics (polymyxins and fosfomycin), tigecycline, and aminoglycosides. All these options have efficacy, resistance, and toxicity issues. Continuous monitoring of the local epidemiology combined with antimicrobial stewardship is mandatory for optimization therapy with the currently available drugs. Infectious control is crucial to limit the spread of resistance.


Hematopoietic stem cell and solid organ transplant recipients Gram-negative rods Enterobacteriaceae Pseudomonas aeruginosa Non-fermentative rods Acinetobacter, Stenotrophomonas, Burkholderia, antimicrobial resistance Antimicrobial stewardship Infections control